Elbow UCL Sprain or Tear (Inner Elbow)

Q: Is the ulnar collateral ligament on the inside or the outside of the elbow?

The inside. The ulnar collateral ligament starts on the bony bump on the inner side of the elbow, the medial epicondyle, and fans down to the ulna, the forearm bone on the little-finger side. Doctors also call it the medial collateral ligament of the elbow. The ligament on the outer side is a different structure.

Q: How do you know if your UCL is torn?

The usual signs are pain on the inside of the elbow, just below the bony bump, as the arm comes through to throw, a throw that has lost speed or accuracy, a pop on one throw, or bruising after a fall. Some people feel tingling into the ring and little fingers. A doctor confirms it and decides on a scan.

Q: How long does recovery take after Tommy John surgery?

Tommy John surgery is UCL reconstruction with a tendon graft. The recovery is long. In a series of 1,281 athletes after reconstruction, the average time from the operation to full competition was 11.6 months. Your surgeon's protocol sets when the brace comes off, when throwing starts and how fast it builds.

Written by Shamaine Soh, Principal Hand Occupational Therapist at Phoenix Rehab, AHPC A1302343D.Clinically reviewed by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z.Last reviewed 7 October 2026.

An elbow UCL sprain is a stretch or tear of the ulnar collateral ligament, the band on the inside of the elbow that stops it bending outward. Repeated throwing strains it. A fall onto an outstretched hand or an arm bar can tear it at once. A pop on the inside of the elbow needs a doctor the same day.

Key takeaways

The UCL is the ligament on the inside of the elbow. It runs from the bony bump on the inner elbow to the ulna, and it stops the elbow bending outward.
Repeated throwing strains it. A fall onto an outstretched hand, a wrestling takedown or an arm bar can tear it at once.
The usual signs are pain on the inside of the elbow as the arm comes through to throw, a ball that falls short or wide, and sometimes tingling into the ring and little fingers.
Golfer’s elbow, the ulnar nerve, a dislocation, a teenager’s inner elbow fracture and a distal biceps rupture can all hurt in the same area. How it started is the first clue.
A doctor confirms the injury and decides on a scan. Reconstruction, often called Tommy John surgery, and any injection are your surgeon’s decision. A hand therapist runs the brace, the strength and the return to throwing in stages.

Is the UCL on the inside or the outside of the elbow?

The inside. Feel for the bony bump on the inner side of your elbow, the one that sends a jolt down to the little finger when you knock it. That bump is the medial epicondyle. The ulnar collateral ligament starts there and fans down to the ulna, the forearm bone on the little-finger side. Doctors also call it the medial collateral ligament of the elbow. The ligament on the outer side is a different structure.

Its job is to stop the elbow bending outward, which doctors call valgus. With the elbow at a right angle, the ligament supplies about half of the elbow’s resistance to that outward push.¹ The muscles that bend your wrist and fingers start on the same bump and share the load. The ulnar nerve runs just behind it, which is why an injured ligament and a tingling little finger often turn up together.

The thumb has a ligament with the same name. A torn thumb UCL is skier’s thumb, covered in sprained thumb. This page is about the elbow.

Sprain, partial tear, complete tear

In a sprain the fibers are stretched and the ligament still holds. In a partial tear some fibers have gone. In a complete tear the ligament no longer holds the inner elbow closed when the arm is loaded outward. Your doctor grades it, and the grade decides the plan.

How it happens, in the order to check

1. Many throws

Every overhand throw cocks the arm back, then whips it forward, and the elbow is pushed outward as it comes through. A softball or baseball pitcher, a cricket fielder throwing in from the boundary, a javelin thrower, a water polo player. The ligament takes a little damage with each hard throw. Over weeks, the inner elbow starts to ache at the moment the arm comes through to release, and the ball starts falling short or drifting wide. See baseball and softball injuries and cricket injuries.

2. One throw, and a pop

A ligament weakened by months of throwing can give on a single throw. People describe a pop or a sharp pull on the inside of the elbow, and they cannot throw hard again that day.

3. A fall or a lock

A fall onto an outstretched hand with the elbow forced outward. A takedown in wrestling where the arm posts on the mat. An arm bar in BJJ held past the tap. These can tear the ligament in one moment, sometimes as part of an elbow dislocation, and they often bruise the inner elbow and forearm.

In children and teenagers the growth plate at the inner elbow bump is weaker than the ligament. The same throw or fall can pull the bump itself off the bone, a medial epicondyle fracture. A young thrower or a teenager with inner elbow pain after a fall sees a doctor first.

How do you know if your UCL is torn?

The pattern points to it: pain on the inside of the elbow, just below the bony bump, that comes on as the arm comes through to throw. A throw that has lost speed or accuracy. A pop on one throw. Bruising on the inner elbow after a fall. The elbow feels as if it opens up on the inside when you throw. Some people also feel tingling into the ring and little fingers.

Can you bend your arm with a UCL tear? Usually yes. The elbow still bends and straightens, and daily life can feel close to normal. The throw is where it shows.

The moving valgus stress test

Doctors and hand therapists use the moving valgus stress test. O’Driscoll and colleagues described it in 2005.² The examiner bends your elbow fully, holds it pushed outward with the shoulder turned back, as if cocked to throw, then straightens it fast. Pain on the inner elbow as it passes through the middle of the arc points to the ligament. In the study that described it, the test picked up all 17 tears later confirmed at operation.²

This one is not a home test, and throwing harder to check tells you nothing new. Whether you need an ultrasound, an X-ray or an MRI is a decision for your doctor.

UCL sprain, golfer’s elbow, ulnar nerve, dislocation, a teenager’s fracture or distal biceps rupture?

Ask three things: how it started, where it hurts, and what brings it on.

Condition	How it started	Where you feel it	What gives it away	What it needs first
UCL sprain or tear	Weeks of throwing, one throw with a pop, or a fall or arm bar forcing the elbow outward	Inside of the elbow, just below the bony bump	Pain as the arm comes through to throw. The ball falls short or wide. Daily life feels close to normal	A doctor the same day after a pop or a fall. Otherwise assessment, and no throwing
Golfer’s elbow	No injury. Builds over weeks of gripping, pulling, curls or swings	Inside of the elbow, on the bony bump itself, spreading into the forearm	Gripping and bending the wrist forward against resistance hurt. Throwing may not	Assessment and graded loading
Ulnar nerve irritation (cubital tunnel)	Builds with throwing, leaning on the elbow, or sleeping with it bent	Behind the inner elbow, then tingling or numbness into the ring and little fingers	Pins and needles with the elbow bent for long, at night or on the phone. Clumsy fingers	Assessment. A doctor if the hand is weakening
Elbow dislocation	A fall onto an outstretched hand	The whole elbow	The elbow looks out of place, or you cannot move it at all	The emergency department now
Inner elbow fracture in a child or teenager (medial epicondyle). See fractured elbow	A throw or a fall in a growing player	On the inner elbow bump, with swelling	Age. The bump is tender to press, and the elbow swells	A doctor first, the same day. The emergency department now after a fall with swelling
Distal biceps rupture	A heavy load forcing a bent elbow straight, with a pop	Front of the elbow crease, bruising into the forearm	Turning the palm up is weak. The biceps bunches up toward the shoulder	A doctor the same day

Can a torn UCL heal on its own?

A sprain and many partial tears are managed without an operation: a stretch of time with no throwing, then strength work and a return to throwing in steps. Whether a complete tear, or a partial tear that keeps failing on the throw, needs an operation is a decision for your orthopedic or hand surgeon. If you have been offered an injection for a partial tear, such as platelet-rich plasma, whether it suits you is a decision for your doctor or surgeon.

Either way, the route to that decision is your GP, a polyclinic, a sports physician, or the emergency department after a fall. Hand therapy cannot reattach a ligament, and nothing on this page replaces that visit. Ask the doctor one question: is the ligament stretched, torn in part, or torn through?

Tommy John surgery: what it is, and who decides

Tommy John surgery is UCL reconstruction, named after the first pitcher to have it. The surgeon rebuilds the ligament with a tendon graft taken from elsewhere in the body. Some tears are repaired instead of rebuilt. Which one, and whether at all, belongs to your surgeon.

The recovery is long. In a series of 1,281 athletes after reconstruction, the average time from the operation to full competition was 11.6 months.³ Your surgeon’s protocol sets when the brace comes off, when throwing starts and how fast it builds.

Elbow UCL sprain treatment: who does what

A doctor (your GP, a polyclinic doctor, a sports physician or the emergency department) examines the elbow, decides on an X-ray, an ultrasound or an MRI, and refers you to a surgeon when it is needed.
An orthopedic or hand surgeon decides whether the ligament needs an operation, repairs or rebuilds it, and decides on any injection.
A hand therapist assesses the elbow, makes or fits a brace or splint when your doctor wants one, brings back range and strength, works the throwing chain from the hip to the hand, and runs the return to throwing in stages. At Phoenix, elbows are seen by our hand therapy team.

The brace, the range and the strength

After a fresh tear or an operation, many doctors want the elbow in a hinged brace that blocks the outward push and limits the range for a time. When yours wants one, a custom thermoplastic splint is molded at the visit, or we fit and set the hinged brace to the range your doctor writes down. The strength work centers on the muscles that start on the inner elbow bump and bend the wrist and fingers, because they share the load with the ligament on every throw.

The throwing chain

The elbow sits at the end of a chain. The legs push, the hips and trunk turn, the shoulder rotates, and the elbow whips through last. A hip that does not turn, a trunk that stays square, or a shoulder short of rotation can leave more of the throw for the inner elbow to take. So we measure the shoulder, the trunk and the hips as well as the elbow, on both sides.

Back to throwing, in stages

In the Phoenix Recovery Protocol the work starts at Calm & Protect: no throwing, the brace or splint if your doctor wants one, and the ulnar nerve checked at every visit. Move & Mobilize brings back full bending and straightening, forearm turning and shoulder rotation. Rebuild & Strengthen loads the forearm muscles on the inner elbow, the grip, the rotator cuff, the shoulder blade, the trunk and the legs. Return & Perform runs the throwing program itself: short, easy throws first, then distance, then effort, with a set number of throws and a day off between. For grapplers it is posting a hand, push-ups and live rolling, in that order. Your doctor or surgeon decides when throwing starts. The criteria decide when it builds.

What we measure

The moving valgus stress test, written down. Where in the arc it hurts, and how much. If it points to a torn ligament and you have not seen a doctor, we write to your doctor that day.
Elbow range. How far the elbow bends and straightens, in degrees, against the other arm.
Grip and the inner forearm muscles. Grip in kilograms on both hands, and the strength of wrist bending and forearm turning against the other arm.
The ulnar nerve. Feeling in the ring and little fingers, and the strength of the small hand muscles.
The shoulder. How far it rotates in and out, in degrees, on both sides.
Trunk and hips. Trunk rotation, hip rotation and single-leg balance on both legs.
The throw. How many throws, at what distance and effort, before the inner elbow speaks up.

Tested, not dated. The plan moves on when the measures say so.

What you can do this week

Stop throwing, all of it, including warm-up tosses and the easy lob back to the bowler.
Write down the date, the throw or the fall, and whether you felt a pop, and take that to the doctor.
Use a cold pack wrapped in a cloth on the inner elbow for 10 to 15 minutes at a time.
Keep the wrist, fingers and shoulder moving within comfort, so the rest of the arm does not stiffen.
If the little finger tingles, stop leaning on the inner elbow and avoid sleeping with the elbow bent tight under the pillow.
Grapplers: no rolling with that arm until a doctor has seen it.
Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.
After an operation: wear the brace as instructed, and do not throw anything your protocol has not allowed yet.

Is this normal?

Usually expected: after a sprain, an inner elbow that aches the day after a throw and settles with rest from throwing. Bruising after a fall that spreads down the inner forearm and fades yellow. After an operation, swelling, a tight scar on the inner elbow, an elbow that does not fully straighten while the brace limits it, and throwing that starts months after the operation.

Worth getting checked: inner elbow pain on throwing that is still there two weeks into a break from throwing. A throw that keeps losing speed. Tingling in the little finger that comes back every time you throw.

When to see a doctor first

Call 995 for arm pain with chest pain, breathlessness or sweating, or a wound that is bleeding heavily and firm pressure does not slow it, or bone showing through the skin.
Go to the emergency department now if the elbow looks out of place after a fall, or you cannot bend or straighten it at all. Also if the hand turns cold, pale or blue, the whole hand goes numb, or the forearm is swelling fast and feels tight with pain far out of proportion to the injury. Also for a child or teenager who fell onto the arm and has a swollen elbow or will not use the arm.
See a doctor the same day for a pop on the inside of the elbow during a throw, pain and bruising on the inner elbow after a fall, an elbow that feels as if it slips or gives, or tingling into the ring and little fingers that started with the injury and has not gone. Also for a young thrower or a teenager with a tender, swollen inner elbow bump. After an operation, contact your surgeon the same day if the wound is red, leaking or more painful, you have a fever, the little finger goes numb for the first time or the hand weakens, or the brace breaks.
See a doctor soon for inner elbow pain on throwing that is still there two weeks into a break from throwing, a throw that has lost speed or accuracy along with inner elbow pain, or tingling into the little finger that keeps coming back.

Where are you with this right now?

1. It was a heavy week of throwing, and it is settling

The ache came after a tournament weekend, with no pop and no fall. A week off throwing and it is quieter every day. Daily life does not touch it, the little finger does not tingle, and the grip feels equal. That is more likely a ligament and forearm muscles that were overloaded and are settling as expected. If the ache sits on the bony bump itself and gripping is what hurts, golfer’s elbow covers it. Come back to throwing short and easy before long and hard. You do not need us for this, and we would rather say so.

2. It has been weeks, and the throw still bites

It went on a throw in from the boundary. A pull on the inside of the elbow, nothing dramatic, so you rested it for a fortnight.

Now the elbow feels fine at the desk and fine on the MRT pole. Then the first hard throw at Sunday practice, and the inner elbow bites as the arm comes through. The ball lands two bounces short of the keeper. You lob it back to the bowler instead of throwing it, and the captain has moved you in from the deep.

Resting it made sense while it was fresh. In your own weeks since, every rest has ended at the same throw.

The ache is gone at rest. Has anyone tested the ligament with your arm cocked back to throw?

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Amazing experience with Phoenix Rehab, was assisted by Mavis. She’s very kind and professional and did thorough check on my wrist. I feel very comfortable during the process.

I went in for thermoplastic splint, and everything went smoothly. She was able to address my needs on my left wrist sprain.

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If the elbow has never been examined, that question goes to a doctor first, through your GP, a polyclinic or a sports physician. If a doctor has seen it and the throw still bites, one Assessment & Treatment with a hand therapist runs the moving valgus stress test, measures the inner forearm, the shoulder and the hips against the other side, treats what is limiting you in the same visit, and tells you which stage you are in. If the ligament looks torn through, we write to your doctor that day.

3. You have had the reconstruction, or you have a date

The surgeon rebuilds or repairs the ligament. The months after decide how the elbow moves, how the forearm holds it, and when the throw comes back. See hand therapy after surgery. Your surgeon’s protocol takes precedence.

If it is months on and the elbow still stops short of straight, the grip is still well short of the other hand, or the throwing program keeps stalling at the same distance, the Stalled Recovery Review is three weeks with the same hand therapist. The first visit measures range, strength and the throw. The next two measure how they respond.

All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.

Next step

Find out which stage you are in

Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.

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